Traumatic injury of the spleen is rare in newborns. Nonoperative management of pediatric splenic injuries is now recognized as the treatment of choice, but there is scant experience with the problem in neonates. The authors report their experience with a neonatal splenic rupture, managed nonoperatively.

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ranking = 1keywords = newborn(Clic here for more details about this article)

Traumatic rupture of the spleen in the newborn is a rare event and is seldom reported in the literature. It can occur to an abnormally enlarged spleen or to a normal spleen. In the latter, it usually is associated with difficult delivery. Previously, the majority of patients died probably because of delayed or missed diagnoses. The classic presentation is a triad of bleeding, abdominal distension, and hemoperitoneum. High index of suspicion and improvement in diagnostic tools like ultrasonography and computed tomography are important contributions in early diagnosis so that appropriate treatment can be implemented. splenectomy is no longer the standard treatment because it increases the chance of postsplenectomy sepsis. Instead, treatment should aim for hemostasis and preservation of spleen. The authors present a case of traumatic rupture of spleen in a normal newborn with normal labor and delivery. The first symptom began at 16 hours of age and evolved to a full-blown classic picture. The baby was saved without splenectomy, and the recovery was smooth and uneventful. This is probably the first reported case of a patient treated without splenectomy in this locality. Discussion of the condition and review of the literature also are presented.

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ranking = 1.2keywords = newborn(Clic here for more details about this article)

wandering spleen is an unusual condition in children and is even more rarely diagnosed in the neonatal period. A case of splenic haemorrhage after dystocic birth in a newborn is reported. Before surgery, results of imaging studies were suggestive of a ruptured spleen. On laparotomy, a big haematoma surrounding a wandering spleen was found. Haemorrhage aroused from short splenic arteria. Haemostasia and splenopexy were performed. The spleen proved later to be viable. The authors speculate that the haemorrhage was the first manifestation of the wandering spleen.

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4/10. Intrapartum rupture of the falciform ligament and umbilical vein. A rare cause of hemoperitoneum in the newborn.

Intra-abdominal hemorrhage in the newborn is uncommon, but it must be considered in the first 48 hours of life in the infant with pallor, anemia, abdominal distension, and shock. The injured liver is the most common source of bleeding, with the spleen and kidney less often involved. In the case presented, the hallmarks of intra-abdominal hemorrhage were evident. Exploratory laparotomy revealed intraperitoneal bleeding emanating from the disruption of the umbilical vein and its enveloping falciform ligament. There was no other site of intra-abdominal bleeding and there were no intrinsic abnormalities of the umbilical cord or the placenta. Disruption of the intra-abdominal umbilical vein represented the sole source of intra-abdominal bleeding in this patient. The case is reported to document disruption of the intra-abdominal umbilical vein as a rare cause of neonatal hemoperitoneum.

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As a result of a traumatic delivery a newborn malechild developed thoracic and intra-abdominal problems. Haemoperitoneum and chylous ascites were diagnosed; from a scrotal enlargement secondary to bilateral patent processus vaginalis and a chylothorax became apparent during investigation of the scrotal swellings. We discuss the presentation, diagnosis and management of the case and review the literature.

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hemoperitoneum in the newborn is usually a result of visceral injury from birth trauma. This report describes an as yet unreported complication of massive hemoperitoneum following suprapubic bladder aspiration.

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ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum in three, and most probably in the fourth as well. Two infants died in spite of antibiotics, vigorous blood replacement, including exchange transfusion, and desperation laparotomies for continued intraperitoneal hemorrhage. Newborns with scrotal ecchymosis should be examined for intraperitoneal hemorrhage, ruptured subcapsular hematoma of the liver being the most probable source. Their coagulation status should also be evaluated, and sepsis should be suspected, especially in those with a demonstrated coagulopathy. Group B streptococcus is a likely primary etiologic agent in these critically ill neonates. Nonoperative treatment, as given the two survivors in this experience, is preferred.

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A case of neonatal hemoperitoneum secondary to umbilical artery catheterization is presented. The only sign of arterial laceration was a rapid accumulation of intraperitoneal fluid following placement of the catheter.

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Neonatal liver laceration is a relatively rare but probably fatal condition without prompt diagnosis and treatment. It should be considered in newborn infants who are presented with sudden onset of symptoms and signs of hemoperitoneum such as shock, pallor, abdominal distension, abdominal bruising, or scrotal ecchymosis. Roentgenogram may show free peritoneal fluid. Abdominal sonography is helpful in the detection of intraabdominal bleeding. paracentesis is the most effective diagnostic procedure for the confirmation of hemoperitoneum. The rupture of the liver is the first priority to be considered, though other abdominal organs including adrenals, kidneys, and spleen are also prone to injury. Once liver laceration is highly suspected, resuscitation with blood transfusion, correction of coagulopathy, and then emergency surgical intervention must be performed if conservative treatment fails. Here we present a 1,662 gm premature male neonate who underwent successful surgical repair of the liver laceration.

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